Complete the form below to report an allegation to OIG. Employees of the U.S. Department of State and the Broadcasting Board of Governors (including current employees, locally-employed staff, and contract employees) are automatically granted confidentiality on any complaints made to OIG. If you choose to remain confidential, this may limit our ability to ensure proper handling and disposition of this matter and may result in closure due to insufficient information. Note: Fields marked by * are required Would you like to submit this form anonymously? (A complaint submitted anonymously does not necessarily prevent an investigation from being initiated based on the facts provided, but can hinder the effective resolution of the complaint). * YesNo Are you willing to waive your confidentiality in the event that your complaint is referred to Department of State/Broadcasting Board of Governors management for resolution? * - Select -YesNo Your Information (not required) Name E-mail Street Address City, State and Zip Phone Number (home, work, cell) Complaint Information Where did this incident of waste, fraud or abuse happen? What date(s) did it happen? What kind of waste, fraud, or abuse are you reporting? (check all that apply) False Statements/Claims Contract/Procurement Fraud Embezzlement/Theft Visa Passport Fraud Conflict of Interest/Ethics Violations Employee Misconduct Other Please summarize what you know about this incident Name of company or individual responsible for this incident Individual's title, if applicable Company or individual's address Company or individual's phone number How do you know this incident occurred? Do you have any further evidence of this incident? (i.e. documents, photos, e-mails, etc.) - Select -YesNo Does anyone else know about this incident? Name Title Address Phone number How do they know of this incident? Is there anything else you want to tell us about this incident? By submitting this form, you certify that all of the statements made in this allegation (including continuation pages and addenda) are true, complete, and correct to the best of your knowledge and you understand that a deliberate false statement, or deliberate concealment of a material fact relating to the allegations herein is a criminal offense (Title 18 U.S.C. Section 1001) for which you may be prosecuted. Leave this field blank Submit
